Individual
MARK CARLESS STACHEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
170 W MOHAWK DR, MALVERN, OH 44644-9564
(330) 489-1477
(330) 430-6925
Mailing address
170 W MOHAWK DR, MALVERN, OH 44644-9564
(330) 489-1477
(330) 430-6925
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35060372
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000136651
BCBS
—
05
—
0839874
—
OH
01
—
1001
SUMMA CARE
—
01
—
110050485
RR MEDICARE
—
01
—
341684794
TAX ID
—
01
—
34168479400
WC
—
Enumeration date
05/27/2005
Last updated
12/19/2020
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